Diarrhea

Symptoms Of Diarrhea

Diarrhea is typically defined as having more than three loose or watery bowel movements in 24 hours. It is often accompanied by:

• Abdominal cramps or pain
• Bloating
• Nausea or vomiting
• Urgent need to use the toilet
• Fever (sometimes)
• Dehydration with dry mouth (xerostomia), dizziness, and tiredness.

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Causes Of Diarrhea

Diarrhea occurs when the balance of fluid absorption and secretion in the intestines is disrupted. Normally, your intestines absorb water from the food you eat. However, in diarrhea, either too little water is absorbed or too much is secreted into the bowel, resulting in frequent, loose, or watery stools. This can happen due to:

• Infections that damage the intestinal lining
• Conditions that impair digestion or nutrient absorption
• Substances (like lactose or certain drugs) that draw water into the bowel

Common causes of diarrhea include:

Infectious causes

• Viral infections (e.g., rotavirus, norovirus)

• Bacterial infections (e.g., E. coli, Salmonella, Shigella)

• Parasitic infections (e.g., Giardia lamblia, Entamoeba histolytica)

Dietary causes

• Food poisoning (contaminated food or water)

• Food intolerances (e.g., lactose intolerance)

Medications

• Antibiotics can disrupt normal gut bacteria

• Magnesium-containing antacids or certain chemotherapy drugs

Digestive disorders

• Irritable bowel syndrome (IBS)

• Inflammatory Bowel Disease (IBD)

• Crohn’s disease 

• Ulcerative colitis

• Celiac disease

• Chronic pancreatitis.

Note: Acute diarrhea is the onset of 3 or more loose or watery stools a day lasting 14 days or less. However, chronic or persistent diarrhea is labeled when an episode lasts beyond 14 days.

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Risk Factors For Diarrhea

Many causes and risk factors for diarrhea often overlap. While causes directly lead to diarrhea, risk factors increase the chance of getting it. Some common risk factors for diarrhea include:

Environmental risk factors

• Unsafe drinking water
• Poor sanitation systems
• Lack of handwashing facilities
• Air pollution (especially household air pollution from solid fuels and ambient particulate matter)
  

Child and maternal health factors

• Malnutrition in children
• Low birth weight and short gestation
• Vitamin A and zinc deficiency
• Lack of breastfeeding in infants

Lifestyle factors

• Inadequate hygiene practices
• Poor food handling or unsafe food consumption
• Frequent travel to high-risk areas
• Use of antibiotics or chemotherapy drugs

Age and immunity

• Weakened immunity due to HIV infection, cancer treatment, etc.

• Children under 5 years and older age groups.

Diagnosis Of Diarrhea

Diarrhea is generally diagnosed from history and physical exams. Tests may be needed to determine the underlying cause. Diagnosis consists of: 

1. History and physical exam

• Your doctor may ask about duration, stool frequency/consistency, presence of blood, food and travel history, and symptoms of dehydration or fever.

• They may also review medication use, like antibiotics, NSAIDs, and magnesium antacids, which may cause diarrhea.

2. Laboratory tests

• Stool culture: These are done to detect infectious organisms (like Salmonella, Shigella, C. difficile) and markers of gut inflammation.

• Hydrogen breath test: This is done after drinking a sugar solution (like lactose). Your breath is analyzed over time to measure hydrogen levels, which indicate carbohydrate malabsorption or intolerance.

3. Blood tests

• Serum electrolytes: This test is done to check for imbalances like low sodium or potassium levels due to fluid loss.

• Serum creatinine: It assesses kidney function, which may be affected by dehydration.

• Random blood sugar: Identifies low blood sugar (especially in children) or underlying diabetes.

• Complete blood count (CBC ): This test is done to detect infection, anemia, or inflammation.

4. Imaging tests

• Endoscopy: Used to examine the gut lining directly in chronic or severe diarrhea to identify inflammation, ulcers, or structural problems.

• CT scan: Ordered when serious complications like intestinal blockage, perforation, or abscess are suspected.

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Specialist To Visit

A general physician is the first point of contact for evaluating symptoms, prescribing basic treatment, and ordering tests for diarrhea. If it's persistent, severe, or accompanied by warning signs, the following specialists may be consulted:

• Gastroenterologist
• Pediatrician
• Infectious disease specialist

A gastroenterologist is a specialist in digestive issues, chronic or unexplained diarrhea, or conditions like IBD, IBS, or celiac disease.

A pediatrician is consulted for children with diarrhea, especially if under 5 years old or showing signs of dehydration.

You may be referred to an infectious disease specialist if diarrhea is due to persistent infections, travel-related bugs, or antibiotic-resistant organisms.

When to see a doctor? 

Seek medical help for diarrhea if you: 

• See no improvement in symptoms after 48 hours
• Have a high fever
• Notice blood or mucus coating in your poo on the poo
• Are experiencing severe pain.

Diarrhea might seem minor, but it can also indicate an underlying health issue. Consult a medical expert for an accurate diagnosis and appropriate treatment.
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Prevention Of Diarrhea

Preventing diarrhea is all about building healthy daily habits and making smart choices that keep your gut happy and strong. Tips that can help include:

Wash your hands

Regular handwashing with soap, especially before eating and after using the toilet, can cut diarrhea risk. 

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Drink clean water

Always drink clean, safe water and avoid food from unhygienic sources to stop germs from entering your body.

Breastfeed your babies

Exclusive breastfeeding for the first 6 months builds immunity and protects against infections like diarrhea.

Have breastfeeding questions? Find answers here.
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Get vaccinated

The rotavirus vaccine protects babies from one of the top causes of severe diarrhea. Adults need vaccines too, especially to protect against infections like cholera, typhoid, and hepatitis A that can cause serious diarrhea.

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Practice food hygiene

Store and prepare food hygienically, avoid leftovers if they haven’t been refrigerated well, and steer clear of reheating rice or meat multiple times.

Add zinc if needed

Zinc supplements during a diarrheal episode help speed up recovery and reduce future episodes

Talk to your doctor before taking any supplements, as they can interfere with your current medications. 
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Take probiotics

Taking probiotics with good bacteria when you're on antibiotics may help prevent diarrhea from medication side effects.

Good sources of probiotics include curd, buttermilk, fermented foods like idlis, dosa, etc. If your diet lacks probiotics, you can also add them through supplements.
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Treatment Of Diarrhea

ORS (Oral Rehydration Solution) is the first and most important step in managing diarrhea. It helps replace lost fluids and electrolytes and can significantly reduce the risk of complications, especially in children. Also, resuming a regular diet soon helps support gut healing. 

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Management of diarrhea consists of:

1. Symptom relief

• Loperamide: It reduces stool frequency. Avoid it if you have bloody or high-temperature diarrhea.

• Bismuth subsalicylate: It is an over-the-counter medicine that helps relieve diarrhea by reducing inflammation, killing bacteria, and protecting the stomach lining

2. Antibiotics

Antibiotics aren't always needed for diarrhea, as most cases are viral and get better on their own. But in some bacterial or parasitic infections, they can reduce severity, prevent complications. Commonly used antibiotics include:

• Sulfamethoxazole+Trimethoprim
• Cefixime
• Ceftriaxone
• Cefotaxime
• Erythromycin
• Doxycycline
• Metronidazole

3. Supportive therapy

• Zinc: Some studies show that zinc supplements can reduce duration and recurrence in children

• Probiotics: May help shorten the course of mild or antibiotic-associated diarrhea.

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Home-care For Diarrhea

Mild, short-term diarrhea can be managed with rehydration, diet adjustments, and soothing the digestive system. Effective home remedies for diarrhea that can help support recovery include:

1. Oral Rehydration Solution (ORS)

Mix 1 liter of clean water with 6 tsp sugar with half tsp salt. Sip frequently to prevent dehydration.

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2. BRAT diet

• Bananas (Kela): It is rich in potassium and easy to digest, and help replace lost nutrients.

• Rice: Boiled rice or rice water is gentle on the stomach and helps bulk up stools.

• Apple sauce: It is a puree made of apples. It contains pectin, which helps firm up stools.

• Toast: Plain and bland, it provides energy without irritating the gut.

3. Other remedies

• Coconut water (Nariyal pani): This is a natural electrolyte drink that rehydrates and soothes the stomach.

• Ginger tea: It can ease nausea and reduce inflammation in the gut.

• Yogurt: Contains natural probiotics that help restore healthy gut bacteria. Take this if you are lactose-tolerant.

What to eat:

• Normal diet once the appetite returns
• Age-appropriate food for children
• Breast milk or formula for infants
• Doctor-recommended diet for chronic cases like food allergies or intolerances.

What to avoid:

• Alcohol
• Caffeinated drinks like coffee and tea
• Sugary drinks, fruit juices, and sweets
• Sugar-free gums and candies
• Fried and fatty foods like fast food, pizza, etc
• Milk and dairy with lactose, especially after acute diarrhea.

Protip: Keep a food diary if you have chronic symptoms to identify triggers. 
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Complications Of Diarrhea

While most diarrhea clears up in a few days, it can sometimes lead to serious complications like: 

• Dehydration: Rapid loss of fluids can cause weakness, dizziness, dry mouth (xerostomia), low urine output, and, in severe cases, shock.

• Electrolyte imbalance: Along with water, important minerals like sodium, potassium, and chloride are lost. This can disrupt heart rhythm, muscle contractions, and nerve signals.

• Kidney dysfunction: Severe or prolonged dehydration may impair kidney function and, in extreme cases, cause kidney failure.

• Lactose intolerance: This is generally temporary, but some people may develop difficulty digesting milk sugar after intestinal infections.

• Skin irritation: Frequent bowel movements may cause soreness, rashes, or even infections around the anal area.

• Malnutrition: Chronic or recurrent diarrhea can lead to poor nutrient absorption, weight loss, and deficiencies.

• Failure to thrive in children: Ongoing diarrhea in infants and young children can slow growth, impair development, and increase susceptibility to other infections.

• Sepsis: In rare cases, bacteria causing diarrhea may enter the bloodstream, triggering a life-threatening infection that needs urgent treatment.

• Hemolytic uremic syndrome (HUS): A rare but severe complication of E. coli infection that can lead to anemia, low platelets, and kidney failure.

Alternative Therapies For Diarrhea

Always consult a doctor before starting any alternative treatment, especially in children, the elderly, or if diarrhea is persistent or severe. Complementary theories that can help include:

Acupuncture 

It involves stimulating specific points on the body to promote healing. Some studies suggest they may help regulate bowel function and reduce symptoms in people with chronic diarrhea or irritable bowel syndrome (IBS), though more research is needed.

Homeopathy

Homeopathic remedies are used based on symptom patterns and patient history. While some people report relief, scientific evidence supporting their effectiveness for diarrhea is limited.